Provider Demographics
NPI:1982187977
Name:MIDDLE WAY PSYCHOTHERAPY, LCSW P.C.
Entity Type:Organization
Organization Name:MIDDLE WAY PSYCHOTHERAPY, LCSW P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RULLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-661-9645
Mailing Address - Street 1:936 SAINT MARKS AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2017
Mailing Address - Country:US
Mailing Address - Phone:646-468-2152
Mailing Address - Fax:
Practice Address - Street 1:115 HENRY ST STE 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2512
Practice Address - Country:US
Practice Address - Phone:607-260-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty